Grading the States 2006: Letter from NAMI Executive Director

We live in a time where people with serious mental illness are at increased risk. State systems are under tremendous financial strain. As this report goes to press, actions that are being considered in Congress are likely to do more harm than good. Sadly, the promise of community mental health remains unfulfilled.

In 1990, NAMI released its last state ratings report. It described a system of services that, despite enormous expenditure of resources, was not "even minimally acceptable." It detailed great regional and state variations in the existing system of care. Sixteen years later, mental illnesses cause more disability than any other class of medical illness in America. Recent reports from the U.S. Surgeon General, President Bush's New Freedom Commission, and the Institute of Medicine describe well a "system in shambles" and the "chasm" between promise and performance.

Simply put, treatment works, if you can get it. But in America today, it is clear that many people living with the most serious and persistent mental illnesses are not provided with the essential treatment they need. As a result, they are allowed to falter to the point of crisis. The outcome of this neglect and lack of will by policymakers remains often horrendous. The number of people with serious mental illness incarcerated in jails and prisons is on the rise. Emergency room use is increasing. The availability of housing is being threatened. Increasingly, access to effective treatments is being limited by many state governments.

This 2006 report, Grading the States: A Report on America's Health Care System for Serious Mental Illness, has a number of audiences. NAMI intends the report to be a consumers' guide to public services for adults with serious mental illness. We hope it will provide elected policymakers with a specific agenda for action. We also intend for this report to promote a dialogue among all stakeholders about what is and what is not working in the mental health system.

This report looks closely at the investment over time that states have made in their public mental health systems serving adults with serious mental illness. Consistency of vision and political will are key factors driving good systems of care. In 2006, the leadership necessary to drive and sustain system development comes from an array of sources that include a state's mental health authority, Medicaid bureau, the governor's office, legislative leadership, and county officials. We have worked to understand how decisions made by each of these entities have influenced the development of a state's mental health system.

Striving for fairness, comprehensiveness, and transparency, we have surveyed consumers and family members, subject-area experts, researchers, administrators, and clinicians, and then focused on those areas we believe matter most to people with serious mental illnesses and their families.

We thank the Stanley Foundation for its funding and ongoing support of this survey. We also thank the State Mental Health Authorities for their willingness to share information with this project. And we thank Dr. E. Fuller Torrey for the vision provided in the 1986, 1988, and 1990 state rating reports. Without those groundbreaking reports, this one would not exist.

It is our strong sense that if we are to move forward, we must routinely engage in assessing the mental health care systems in every state. It is our intention with this report, and future reports, to stimulate dialogue about what is and what is not working in America. We look forward to releasing the follow-up to this report several years hence. We encourage State Mental Health Authorities to reply and we will print their responses on our Web site, to continue the essential dialogue of advancing our shared system. Your comments will allow us to strengthen such surveys. We hope that our publication of these reports at regular intervals will over time drive the creation of service systems in all states that are not "patchwork relics," but ones of hope, opportunity, and recovery.